Transfusion of blood components containing ABO-incompatible plasma does not lead to higher mortality in civilian trauma patients

Jansen N Seheult, Nancy M Dunbar, John R Hess, Erin E Tuott, Mohammad Bahmanyar, Jessica Campbell, Magali Fontaine, Jenna Khan, Ara Ko, Jian Mi, Michael F Murphy, Tara Nykoluk, Jessica Poisson, Jay S Raval, Andrew Shih, Jason L Sperry, Julie Staves, Michelle Wong, Matthew T S Yan, Alyssa Ziman, Mark H Yazer, Biomedical Excellence for Safer Transfusion (BEST) collaborative

Transfusion. 2020 Nov;60(11):2517-2528

Background: This study investigated the effect on mortality of transfusing ABO-incompatible plasma from all sources during trauma resuscitation.

Methods: Demographic, transfusion, and survival data were retrospectively extracted on civilian trauma patients. Patients were divided by receipt of any quantity of ABO-incompatible plasma from any blood product (incompatible group) or receipt of solely ABO-compatible plasma (compatible group). The primary outcome was 30-day mortality, while other outcomes included 6- and 24-hour mortality. Mixed-effects logistic regression was used to model the effect of various predictor variables, including receipt of incompatible plasma, on mortality outcomes.

Results: Nine hospitals contributed data on a total of 2618 trauma patients. There were 1282 patients in the incompatible group and 1336 patients in the compatible group. In both the unadjusted and adjusted models, the 6-hour, 24-hour, and 30-day mortality rates were not significantly different between these groups. The patients in the incompatible group were then divided into high volume (>342 mL) and low volume (≤342 mL) incompatible plasma recipients. In the adjusted model, the high-volume group had higher 24-hour mortality when the Trauma Injury Severity Score survival prediction was >50%. Mortality at 6 hours and 30 days was not higher in this model. The low-volume group did not have increased mortality at any of the time points in this adjusted model.

Conclusion: The transfusion of incompatible plasma in civilian trauma resuscitation does not lead to higher 30-day mortality. The finding of higher mortality in a select group of recipients in the secondary analysis warrants further study.